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(Circulation. 1969;39:297.)
© 1969 American Heart Association, Inc.

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A Study of Heart Block in Man Using His Bundle Recordings

ANTHONY N. DAMATO M.D.¹; SUN H. LAU M.D.¹; RICHARD HELFANT M.D.¹; EMANUEL STEIN M.D.¹; ROBERT D. PATTON M.D.¹; BENJAMIN J. SCHERLAG PH.D.¹; WALTER D. BERKOWITZ M.D.¹

¹ From the Cardiopulmonary Laboratory, U. S. Public Health Service Hospital, Staten Island, New York.

The technique of recording His bundle electrograms in man by a tripolar electrode catheter was applied in a study of patients with first, second, and third-degree heart block. In all patients with first-degree heart block (congenital, acquired, or induced by atrial pacing), the delay in A-V conduction occurred proximal to the His bundle as evidenced by a prolonged P-H interval. The enhancement of A-V conduction (shortening the P-H interval) due to isoproterenol was qualitatively similar in the three forms of first-degree block. In cases of Wenckebach phenomenon the P-H interval progressively increased until a dropped beat occurred. The nonconducted P wave was not followed by a His deflection, indicating block proximal to the His bundle. Cases of 2:1 and 3:1 block occurring proximal to the His bundle were also studied. The usefulness of His-bundle recordings in the diagnosis of cases of complete and incomplete bilateral bundle-branch block is also demonstrated.

Key Words: Wenckebach phenomenon • Atrial pacing • Bilateral bundle-branch block • A-V conduction

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